Purpose: It is believed that oral intake maintains quality of life (QOL) in terminally ill patients. However, there are few studies assessing oral intake in such patients. The aim of this study is to assess the last oral intake and the effect of nutritional intervention in terminal cancer patients.

Methods: 247 patients who died in the palliative care unit in our institution were surveyed retrospectively over the period from their last meal to death. We also examined the type of last meal or the effect of nutritional intervention.

Result: 154 patients (62.3%) ate something within 1 week before their deaths. Of patients who could eat something during the last week of life, 64.3% consumed jelly or a liquid diet for their last meals. Our nutritional intervention could increase significantly oral intake only for the patients who could keep to eat for a week after their diet counseling.

Conclusion: More than 60% of patients could eat something just before their deaths. Although the number of eligible patients was limited, nutritional intervention could increase oral diet.

Objective: We investigated whether objective evaluation by using the palliative prognostic index (PPI), prognostic nutritional index (PNI), and controlling nutritional status (CONUT) can provide prognostic information during the transition from chemotherapy to palliative care in patients with metastatic colorectal cancer.

Methods: The subjects were 79 patients with colorectal cancer who died of their disease between April 2009 and March 2015.

Results: The PPI score and CONUT score for patients who died within 90 days of completing chemotherapy were significantly higher than the scores for patients who survived for 90 or more days. The PNI score for patients who died within 90 days of completing chemotherapy was significantly lower than the score for patients who survived for 90 or more days. The surviving number of days for patients with PPI score under 3 or with PNI score 40 and over or with higher CONUT score were significantly shorter.

Conclusion: Our study suggests that the PPI, PNI, and CONUT may be useful for objective evaluation during the transition from chemotherapy to palliative care.

Purpose: Oral care is not targeted for specific bacteria, but it is important that it reduce the absolute number of oral bacteria to be useful for treatment and prevention at patients associated with aspiration pneumonia. We investigated the association between the treatment plan and prognostic value as a reference to evaluate bacterial flora of the mouth and the nutritional state of patients associated with aspiration pneumonia.

Subjects and methods: The investigation included 68 patients associated with aspiration pneumonia who had a mouth care request and were admitted to our hospital from April, 2013 to June, 2016. We evaluated the oral bacteria and nutritional state of the patients at the time of the mouth care intervention using CONUT (controlling nutritional status score).

Results: Fatalities increased significantly when there was a higher rate of detection of Klebsiella.P, Enterobacter, and Corynebacterium when comparing pneumonia improvement subjects and fatalities (p<0.05: χ²test). Regarding the nutritional evaluation by CONUT, a poor nutritional state was detected in 88% of fatalities, and the poor nutritional state was significantly higher in the pneumonia improvement subjects and the fatalities (p<0.01: χ²test). In addition, a poor nutritional state was more frequent in the age group greater than 80 years old (p<0.05: χ²test).

Conclusion: Causation was accepted by the bacterial flora of the mouth of the patients associated with aspiration pneumonia and the nutritional state and prognosis. Continuing oral care is necessary because aspiration-related pneumonia in elderly people having various basal diseases is fatal. We think the bacteriological monitor is important as an objective intraoral evaluation for the state of oral hygiene, for the reference of prognostic values and treatment plans and for recurrence prevention.

Objective: We examined pharmacists' ward services and their involvement in nutritional management involving the pharmacies of hospitals in Osaka Prefecture.

Methods: Questionnaire surveys were conducted in 2012 and 2014. The survey contents consisted of the current status of pharmacists' ward services, injection-mixing/preparing services, and the nutrition support team (NST) activities. The results were compared between 2012 and 2014.

Results: The numbers of full-time pharmacists in 2012 and 2014 were 8.4 and 13.1, respectively. Among the institutions where pharmacists were continuously engaged in ward services, 24.1 and 31.4% answered that such pharmacists were assigned to all wards in 2012 and 2014, respectively, revealing an increase in the proportion. In 2012, the proportion of institutions where pharmacists were completely or mostly responsible for fluid preparation for central venous hyperalimentation was 30.3%. In 2014, it was 44.1%, showing a significant increase. The proportion of institutions where pharmacists were responsible for anticancer drug-mixing/preparing services was 47.3 and 58.8%, respectively, in 2012 and 2014, showing a slight increase. The proportion of institutions where NST functioned significantly increased from 61.6 (2012) to 76.4% (2014).

Conclusion: The results suggest that the adoption of additional fees for ward pharmacy services increased the number of pharmacists, expanded the range of their activity on wards, and enhanced their awareness of nutritional management, consequently promoting their participation in NST. This may have greatly contributed to nutritional and risk management, as well as team medicine.

Patients and methods: 56 patients with pneumonia, aged over 75 years old, after excluding nursing - and healthcare-associated pneumonia and aspiration pneumonia, were enrolled in this study. They were divided into two groups: patients with swallowing disorder (Group D, n = 14), and patients without swallowing disorder (Group N, n = 42), when they were discharged from the hospital.

Results: In Group D, patient's food intake was significantly more restricted compared with that in Group N. The timing of intervention by a speech therapist was the same in both groups. Physical therapy had been started significantly earlier for Group N than for Group D. The Barthel Index at the start of physical therapy was significantly lower in Group D than Group N. The Barthel Index at discharge from the hospital was significantly higher than that at the start of physical therapy in both groups. Furthermore, the difference in the Barthel index between the two groups disappeared at the time of discharge from the hospital. The duration of fasting was suggested to be related to developing swallowing disorder during treatment for pneumonia in the elderly. In addition, a delay in the start of physiotherapy was suggested to be related to the development and protraction of swallowing disorder. Furthermore, it was considered that such a swallowing disorder was not improved only by physiotherapy.

Conclusion: An early assessment of the swallowing function by ST, appropriate nutritional support, and adequate physiotherapy may be mandatory for the medical treatment of the elderly with pneumonia.